Project Summary Advanced Training in Nursing Outcomes Research This a competing continuation of Penn Nursing's T32NR007104 pre- and post-doctoral training program in nursing outcomes research now in its 19th year. Ninety-two percent of T32 PhD alumni and 94% of postdoctoral alumni are faculty at research-intensive institutions; 77% of PhDs and 79% of postdoctoral trainees have competed successfully for research funding post training. Trainees were recruited from a robust national pool of applicants and are now employed in 44 different institutions in 24 states. Over the life of the T32, 34% of trainees have been minorities. Funding is requested for continuation of 5 pre-doctoral positions, and a reduction of post-doctoral trainees from 4 to 3 to enable investments in more postdoctoral trainee coursework in advanced quantitative methods. The T32 is embedded in the award-winning Center for Health Outcomes and Policy Research (CHOPR) at Penn Nursing that provides trainees with exemplary resources and learning opportunities. These include: 1) mentorship by prominent CHOPR nurse researchers who have 7 currently funded R01s in nursing outcomes research plus other funded large-scale studies; 2) CHOPR analytic staff designated to support T32 training in computer applications for Big Data; 3) T32 nurse investigator preceptors from Penn Nursing whose research is in the new emphasis topics of serious illness; 4) a large interdisciplinary T32 faculty with relevant funded research and expertise in advanced quantitative methods; and 5) access to a unique and robust Big Data inventory from CHOPR's NIH/AHRQ research, the Leonard Davis Institute of Health Economics' health services research data repository, and the clinical data warehouse of the large University of Pennsylvania Health System. The training emphasis continues to focus on areas of research in which T32 faculty and trainees have made significant contributions to the advancement of knowledge about the impact of nursing on patient outcomes exemplified by the T32 faculty's research published in The Lancet and highlighted in the current NINR Strategic Plan. The T32 is enhancing the pipeline of nurses into PhD study by recruiting BSN to PhD applicants and expediting PhD training to completion in 3 years, an objective that we have been successfully achieving. In this application, we specify new areas of inquiry that extend the testing of our central thesis that the potentially modifiable organizational context of nursing practice across settings of care and patient populations is significantly associated with care outcomes. New directions include nursing's impact on clinical outcomes among seriously ill and high-need patients across the lifespan and across settings. This focus reflects the priority set by the National Academy of Medicine's report Effective Care for High-Need Patients that require a disproportionate share of nursing care. We heed the call in the NIH Strategic Plan for Data Science to enhance research training by emphasizing data science and Big Data approaches.